Digital health and wearable devices for retinal disease monitoring.

Digital health is wielding a growing influence across all areas of healthcare, encompassing various facets such as telemedicine, artificial intelligence (AI), and electronic healthcare records. In Ophthalmology, digital health innovations can be broadly divided into four categories: (i) self-monitoring home devices and apps, (ii) virtual and augmented reality visual aids, (iii) AI software, and (iv) wearables. Wearable devices can work in the background, collecting large amounts of objective data while we do our day-to-day activities, which may be ecologically more valid and meaningful to patients than that acquired in traditional hospital settings. They can be a watch, wristband, piece of clothing, glasses, cane, smartphone in our pocket, earphones, or any other device with a sensor that we carry with us. Focusing on retinal diseases, a key challenge in developing novel therapeutics has been to prove a meaningful benefit in patients' lives and the creation of objective patient-centred endpoints in clinical trials. In this review, we will discuss wearable devices collecting different aspects of visual behaviour, visual field, central vision, and functional vision, as well as their potential implementation as outcome measures in research/clinical trial settings. The healthcare landscape is facing a paradigm shift. Clinicians have a key role of collaborating with the development and fine-tuning of digital health innovations, as well as identifying opportunities where they can be leveraged to enhance our understanding of retinal diseases and improve patient outcomes.

Is developmental plasticity triggered by DNA methylation changes in the invasive cane toad (Rhinella marina)?

Many organisms can adjust their development according to environmental conditions, including the presence of conspecifics. Although this developmental plasticity is common in amphibians, its underlying molecular mechanisms remain largely unknown. Exposure during development to either 'cannibal cues' from older conspecifics, or 'alarm cues' from injured conspecifics, causes reduced growth and survival in cane toad (Rhinella marina) tadpoles. Epigenetic modifications, such as changes in DNA methylation patterns, are a plausible mechanism underlying these developmental plastic responses. Here we tested this hypothesis, and asked whether cannibal cues and alarm cues trigger the same DNA methylation changes in developing cane toads. We found that exposure to both cannibal cues and alarm cues was associated with local changes in DNA methylation patterns. These DNA methylation changes affected genes putatively involved in developmental processes, but in different genomic regions for different conspecific-derived cues. Genetic background explains most of the epigenetic variation among individuals. Overall, the molecular mechanisms triggered by exposure to cannibal cues seem to differ from those triggered by alarm cues. Studies linking epigenetic modifications to transcriptional activity are needed to clarify the proximate mechanisms that regulate developmental plasticity in cane toads.

Mechanisms, costs, and carry-over effects of cannibal-induced developmental plasticity in invasive cane toads.

Inducible defences can improve survival in variable environments by allowing individuals to produce defences if they detect predators. These defences are often expressed as inter-related developmental, morphological, and behavioural changes. However, producing defences can incur costs, which may be expressed immediately and/or during subsequent life stages. In Australia, waterborne cues of potentially cannibalistic conspecific tadpoles induce hatchlings of invasive cane toads to accelerate their developmental rate, thereby reducing their window of vulnerability. However, the mechanisms and costs of such accelerated development are poorly understood, and whether cane toad embryos show cannibal-induced plasticity in other traits is unknown. Here, we found no evidence of altered time of hatching for embryos exposed to non-feeding conspecific cannibal tadpole cues. Additionally, hatchling dispersal behaviours were not affected by exposure to these cues. However, developmental acceleration of hatchlings induced by exposure to tadpole cues was accompanied by reduced hatchling growth, indicating a trade-off between these processes. At the conclusion of the hatchling stage, cannibal-exposed individuals were smaller and morphologically distinct from control siblings. This size reduction affected performance during the subsequent tadpole stage: smaller cannibal-exposed individuals were more likely to die, and initial size tended to be positively associated with subsequent tadpole growth and development across treatments (respectively, p = .07 and p = .06). However, even accounting for variation in initial size, there was an additional negative effect of cannibal exposure on tadpole growth and development, demonstrating that the fitness costs associated with developmental acceleration are not entirely attributable to size reductions.

Eccentric Viewing Training for Age-Related Macular Disease: Results of a Randomized Controlled Trial (the EFFECT Study).

Purpose: Eccentric viewing training for macular disease has been performed for > 40 years, but no large studies including control groups have assessed the benefits of this training. The EFFECT (Eccentric Fixation From Enhanced Clinical Training) study is a large randomized controlled trial of 2 types of eccentric viewing training. Design: Randomized controlled trial. Participants: Two hundred adults with age-related macular disease. Methods: Participants were randomized to either of the following: (1) a control group; (2) a group receiving supervised reading support; (3) a group receiving 3 sessions of training to optimize the use of their own preferred retinal locus; or (4) a group receiving 3 sessions of biofeedback training of a theoretically optimal trained retinal locus. All participants received standard low-vision rehabilitation. Main Outcome Measures: The primary outcome was patient-reported visual task ability measured on the Activity Inventory instrument at goal level. Secondary outcomes included reading performance and fixation stability. Results: There was no difference between groups on change in task ability (F(3,174) = 1.48, P = 0.22) or on any of the secondary outcome measures. Visual acuity and contrast sensitivity fell in all groups, suggesting that disease progression outweighed any benefit of training. Conclusions: Eccentric viewing training did not systematically improve task ability, reading performance, or fixation stability in this study. Our results do not support the routine use of eccentric viewing training for people with progressing age-related macular disease, although this training may help people with end-stage disease. Rehabilitation of an inherently progressive condition is challenging. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Can children measure their own vision? A comparison of three new contrast sensitivity tests.

PURPOSE: To investigate the feasibility of children measuring their own contrast sensitivity using a range of tablet- and paper-based tests. METHODS: Forty children aged 5-15 years with amblyopia (N = 10), bilateral vision impairment (N = 10) or good vision (N = 20) measured their own vision on a screen-based optotype test (Manifold), a gamified vision test (PopCSF) and a paper-based test (Spotchecks) in a laboratory with minimal supervision. Completion rate, test-retest repeatability, test duration and participants' preferences were recorded for each test. RESULTS: Most participants (36/40) were able to perform all three tests. All tests were correlated with clinically measured visual acuity and contrast sensitivity (p < 0.001). The 95% coefficient of repeatability was 0.30 dB for Manifold, 0.29 dB for PopCSF and 0.13 dB for Spotchecks. All tests differentiated between children with reduced contrast sensitivity and control participants. PopCSF and Spotchecks were also able to differentiate between children with amblyopia and those with good vision. Median test time was 152, 130 and 202 s for Manifold, PopCSF and Spotchecks, respectively. Twenty-two participants preferred the PopCSF test, 10 preferred Spotchecks and 6 preferred Manifold. Thirty-nine out of the 40 children (98%) said they would measure their own vision at home using at least one of these tests every month. CONCLUSIONS: Children and young people can test their own contrast sensitivity with repeatable results. Of these three tests, the most repeatable was Spotchecks, the quickest was PopCSF and participants' favourite was PopCSF. Nearly all of the participants said they would be willing to use at least one of the three tests at home.

"I'm like something out of star wars": a qualitative investigation of the views of people with age-related macular degeneration regarding wearable electronic vision enhancement systems.

PURPOSE: This study explores the initial views of people with age-related macular degeneration towards wearable electronic vision enhancement systems. METHODS: Ten adults with age-related macular degeneration participated in semi-structured interviews, which were analysed using reflexive thematic analysis. RESULTS: Four themes were identified. Firstly, participants spoke of the wide-ranging impact of sight loss and how current helpful coping strategies still had significant limitations, affecting their desire to seek new solutions. The second theme showed that "other people" offered welcomed support with existing electronic coping solutions and are needed to provide suitable advice and training. However, "other people" limited the acceptability of using new solutions in public places. The third theme captured participants' desire for a wearable aid providing image magnification and enhancement over a range of distances. The final theme covered the reality of some current wearable technology, perceived as heavy, enclosing, or strange in appearance. Appearance caused some to lose interest in use, although others reframed the devices' desired usefulness to solo and sedentary activities. CONCLUSION: This population are interested in the potential benefits of wearable electronic vision enhancement systems. More work is needed to understand the suitability of current solutions due to participant concerns about training, appearance and performance.

A device that offers image enhancement and variable magnification in a hands-free, wearable form is very desirable to people with age-related macular degeneration.Some potential users are not seeking new solutions to well-described problems, which may be a useful coping strategy but alternatively may be motivated by fear of the unknown, financial worries, or concerns about appropriate training.The weight and appearance of some of the current wearable electronic vision enhancement systems are not immediately appealing and would stop some from proceeding with a performance trial.After viewing the current devices, the desirable times to use a wearable electronic vision enhancement system may be reframed by users to focus predominately on sedentary tasks taking place in isolation at home.

A biological invasion reduces rates of cannibalism by Japanese toad tadpoles.

Biological invasions can favour rapid changes in intraspecific competitive mechanisms such as cannibalism by imposing novel evolutionary pressures. For example, cane toad (Rhinella marina) tadpoles are highly cannibalistic on eggs and hatchlings in their invasive range in Australia, but not in their native range in South America. Whether such changes in cannibalism occur in invasive populations of other amphibian species is unknown. To explore this question, we collected wild-laid egg clutches of Japanese common toads (Bufo japonicus) from native and invasive populations in Japan, and conducted laboratory experiments to examine cannibalism responses. Contrary to the Australian system, we found that invasion has been accompanied by reduced cannibalistic tendency of B. japonicus tadpoles. This reduction has occurred despite invasive-range B. japonicus eggs/hatchlings being more vulnerable than native-range B. japonicus eggs/hatchlings to cannibalism by native-range conspecific tadpoles, and to predation by native-range frog tadpoles. Our findings thus support the idea that biological invasions can generate rapid changes in rates of cannibalism, but also show that decreases as well as increases can occur. Future work could investigate the proximate cues and selective forces responsible for this rapid decrease in rates of cannibalism by tadpoles in an invasive B. japonicus population.

Are wearable electronic vision enhancement systems (wEVES) beneficial for people with age-related macular degeneration? A scoping review.

INTRODUCTION: Age-related macular degeneration (AMD) is the most common cause of irreversible visual impairment in the United Kingdom. It has a wide-ranging detrimental impact on daily living, including impairment of functional ability and quality of life. Assistive technology designed to overcome this impairment includes wearable electronic vision enhancement systems (wEVES). This scoping review assesses the usefulness of these systems for people with AMD. METHODS: Four databases (Cumulative Index to Nursing and Allied Health Literature, PubMed, Web of Science and Cochrane CENTRAL) were searched to identify papers that investigated image enhancement with a head-mounted electronic device on a sample population that included people with AMD. RESULTS: Thirty-two papers were included: 18 studied the clinical and functional benefits of wEVES, 11 investigated use and usability and 3 discussed sickness and adverse effects. CONCLUSIONS: Wearable electronic vision enhancement systems provide hands-free magnification and image enhancement producing significant improvements in acuity, contrast sensitivity and aspects of laboratory-simulated daily activity. Adverse effects were infrequent, minor and spontaneously resolved with the removal of the device. However, when symptoms arose, they sometimes persisted with continued device usage. There are multi-factorial influences and a diversity of user opinions on promotors to successful device use. These factors are not exclusively driven by visual improvement and incorporate other issues including device weight, ease of use and inconspicuous design. There is insufficient evidence of any cost-benefit analysis for wEVES. However, it has been shown that a user's decision to make a purchase evolves over time, with their estimates of cost falling below the retail price of the devices. Additional research is needed to understand the specific and distinct benefits of wEVES for people with AMD. Further patient-centred research should assess the benefits of wEVES in user-led activities when directly compared with alternative coping strategies, allowing professionals and users to make better prescribing and purchasing decisions.

Comparing Home- and Clinic-Based Visual Acuity Testing.

This study compares visual acuity testing at home with visual acuity testing in a clinical setting.

Choosy cannibals: Targeted consumption of conspecific hatchlings by larval cane toads is triggered by species-specific defensive toxins.

In many species, cannibalism is uncommon and involves nonselective consumption of conspecifics as well as heterospecifics. However, within their invasive Australian range, cane toad larvae (Rhinella marina) specifically target and voraciously consume the eggs and hatchlings of conspecifics, often extirpating entire clutches. In contrast, toad larvae rarely consume the eggs and hatchlings of native frogs. Here, we use laboratory studies to demonstrate that this selective consumption is triggered by species-specific chemical cues: maternally-invested bufadienolide toxins that otherwise defend cane toad eggs and hatchlings against predators. We find that these cues stimulate feeding behaviors in toad tadpoles, such that the addition of bufadienolide toxins to the water column increases predation on eggs, not only of conspecifics, but also of native anuran species that are otherwise usually ignored. In contrast, we find that cannibalism rates on conspecific hatchlings are high and unaffected by the addition of bufadienolide cues. The maternally-invested toxins present in conspecific eggs may therefore be more easily detected post-hatching, at which point tadpole feeding behaviors are induced whether or not additional toxin cues are present. As bufadienolide cues have previously been found to attract toad tadpoles to vulnerable hatchlings, our present findings demonstrate that the same toxin cues that attract cannibalistic tadpoles also induce them to feed, thereby facilitating cannibalism through multiple behavioral effects. Because native fauna do not produce bufadienolide toxins, the species specificity of these chemical cues in the Australian landscape may have facilitated the evolution of targeted (species-specific) cannibalism in invasive cane toad populations. Thus, these bufadienolide toxins confer cost (increased vulnerability to cannibalism in early life-stages) as well as benefit (reduced vulnerability to predation by other taxa).

Competition between the tadpoles of Japanese toads versus frogs.

Competition within and among species can play a key role in structuring the assemblages of anuran tadpoles. Previous studies have reported that tadpoles of the invasive cane toad (Rhinella marina) are more strongly disadvantaged by the presence of native frog tadpoles than by the same number of conspecific toad tadpoles. That effect might arise from a lack of coevolution of the invasive toad with its competitors; and/or from a generalized superiority of frog tadpoles over toad tadpoles. To clarify those possibilities, we conducted experimental trials using the larvae of a native rather than invasive toad (Bufo japonicus formosus in Japan) exposed to larvae of native anurans (the sympatric frogs Rana japonica and Rana ornativentris and the parapatric toad Bufo japonicus japonicus). In intraspecific competition trials, higher densities of B. j. formosus prolonged the larval period and reduced size at metamorphosis, but did not affect survival. In interspecific competition trials, the effects of the other anuran species on B. j. formosus were similar to the effects of the same number of conspecific larvae. This similarity in impact of interspecific versus intraspecific competition argues against any overall competitive superiority of frog larvae over toad larvae. Instead, the vulnerability of larval cane toads to frog tadpoles may result from a lack of coevolutionary history.

Novel use of a Franklin split lens for cycling with hemianopia.

PURPOSE: Optical rehabilitation for hemianopia includes the prescription of partial aperture prismatic lenses. Fresnel lenses for this purpose have poor optical quality, while bonded lenses have poor cosmesis and can only be made in glass, creating a potential hazard. Here we present an alternative lens type, which does not reduce contrast sensitivity and which can be made in plastic materials. METHODS: A rotated Franklin split lens was prescribed for the right eye only to provide a full aperture prismatic lens without using a Fresnel prism or bonded lenses. Using different refractive indices in each lens provided a minimal transition in thickness and an acceptable cosmetic appearance. This lens was prescribed to a 34-year-old woman with homonymous right hemianopia. Her contemporaneous comments are presented. RESULTS: The rotated Franklin split lens provided 18Δ over the temporal edge of the lens. The wearer noticed chromatic aberration with this lens, but was able to cycle comfortably when wearing the lens without any reduction in contrast. CONCLUSIONS: A rotated Franklin split lens can be used for the optical rehabilitation of hemianopia. In this case study, cycling was possible with this lens.

The evolution of targeted cannibalism and cannibal-induced defenses in invasive populations of cane toads.

Biotic conflict can create evolutionary arms races, in which innovation in one group increases selective pressure on another, such that organisms must constantly adapt to maintain the same level of fitness. In some cases, this process is driven by conflict among members of the same species. Intraspecific conflict can be an especially important selective force in high-density invasive populations, which may favor the evolution of strategies for outcompeting or eliminating conspecifics. Cannibalism is one such strategy; by killing and consuming their intraspecific competitors, cannibals enhance their own performance. Cannibalistic behaviors may therefore be favored in invasive populations. Here, we show that cane toad tadpoles (Rhinella marina) from invasive Australian populations have evolved an increased propensity to cannibalize younger conspecifics as well as a unique adaptation to cannibalism-a strong attraction to vulnerable hatchlings-that is absent in the native range. In response, vulnerable conspecifics from invasive populations have evolved both stronger constitutive defenses and greater cannibal-induced plastic responses than their native range counterparts (i.e., rapid prefeeding development and inducible developmental acceleration). These inducible defenses are costly, incurring performance reductions during the subsequent life stage, explaining why plasticity is limited in native populations where hatchlings are not targeted by cannibalistic tadpoles. These results demonstrate the importance of intraspecific conflict in driving rapid evolution, highlight how plasticity can facilitate adaptation following shifts in selective pressure, and show that evolutionary processes can produce mechanisms that regulate invasive populations.

Chemical cues that attract cannibalistic cane toad (Rhinella marina) larvae to vulnerable embryos.

Chemical cues produced by late-stage embryos of the cane toad (Rhinella marina) attract older conspecific larvae, which are highly cannibalistic and can consume an entire clutch. To clarify the molecular basis of this attraction response, we presented captive tadpoles with components present in toad eggs. As previously reported, attractivity arises from the distinctive toxins (bufadienolides) produced by cane toads, with some toxins (e.g., bufagenins) much stronger attractants than others (e.g., bufotoxins). Extracts of frozen toad parotoid glands (rich in bufagenins) were more attractive than were fresh MeOH extracts of the parotoid secretion (rich in bufotoxins), and purified marinobufagin was more effective than marinobufotoxin. Cardenolide aglycones (e.g., digitoxigenin) were active attractors, whereas C-3 glycosides (e.g., digoxin, oubain) were far less effective. A structure-activity relationship study revealed that tadpole attractant potency strongly correlated with Na+/K+ ATPase inhibitory activity, suggesting that tadpoles monitor and rapidly react to perturbations to Na+/K+ ATPase activity.

Intergenerational effects of manipulating DNA methylation in the early life of an iconic invader.

In response to novel environments, invasive populations often evolve rapidly. Standing genetic variation is an important predictor of evolutionary response but epigenetic variation may also play a role. Here, we use an iconic invader, the cane toad (Rhinella marina), to investigate how manipulating epigenetic status affects phenotypic traits. We collected wild toads from across Australia, bred them, and experimentally manipulated DNA methylation of the subsequent two generations (G1, G2) through exposure to the DNA methylation inhibitor zebularine and/or conspecific tadpole alarm cues. Direct exposure to alarm cues (an indicator of predation risk) increased the potency of G2 tadpole chemical cues, but this was accompanied by reductions in survival. Exposure to alarm cues during G1 also increased the potency of G2 tadpole cues, indicating intergenerational plasticity in this inducible defence. In addition, the negative effects of alarm cues on tadpole viability (i.e. the costs of producing the inducible defence) were minimized in the second generation. Exposure to zebularine during G1 induced similar intergenerational effects, suggesting a role for alteration in DNA methylation. Accordingly, we identified intergenerational shifts in DNA methylation at some loci in response to alarm cue exposure. Substantial demethylation occurred within the sodium channel epithelial 1 subunit gamma gene (SCNN1G) in alarm cue exposed individuals and their offspring. This gene is a key to the regulation of sodium in epithelial cells and may help to maintain the protective epidermal barrier. These data suggest that early life experiences of tadpoles induce intergenerational effects through epigenetic mechanisms, which enhance larval fitness. This article is part of the theme issue 'How does epigenetics influence the course of evolution?'

Design considerations for the ideal low vision aid: insights from de-brief interviews following a real-world recording study.

PURPOSE: Low Vision Aids (LVAs) can have a transformative impact on people living with sight loss, yet the everyday requirements for developing such devices remain poorly understood and defined. This study systematically explored LVA requirements through a structured de-brief interview following a real-world self-recording study. The purpose of this work was to define the actual needs of those living with sight loss so that low vision services can better address them in future. METHODS: Thirty-two visually impaired volunteers with varying levels of previous LVA experience participated in a de-brief interview centred around a structured questionnaire. The de-brief followed a one-week real-world study during which participants used recoding spectacles to capture and narrate all situations in which they would use a 'perfect sight aid'. Content and thematic analyses were used to analyse interviews which had the purpose of contextualising these recordings and exploring requirements around psychological, functional and design factors. RESULTS: Participants reported that 46% of tasks which they had recorded were most important to them. Of these tasks, 82% were encountered frequently. Few tasks emerged as very important across many participants, the remaining tasks reflecting individual lifestyles or circumstances. Every participant used at least one LVA in their everyday life and 72% identified further coping strategies. Current LVAs identified as consistently poor were distance LVAs, with all other devices receiving mixed or only positive feedback. Around two-thirds of participants would prefer LVA use on an ad-hoc / quick access basis rather than over long periods of time, and just over half would prefer to carry it rather than wearing it all day. Lack of consistency in these responses illustrated potentially different user clusters with divergent design needs. Two-thirds of participants emphasised the desire for a discreet LVA that does not attract attention. However, since half of all participants felt self-conscious in public or in front of other people when wearing the small recording spectacles, this may not be technically achievable. CONCLUSIONS: There is a substantial opportunity for new LVAs to address visual needs that traditional devices and coping strategies cannot support. Functional, psychological and design factors require careful consideration for future LVAs to be relevant and widely adopted.

Lockdown low vision assessment: an audit of 500 telephone-based modified low vision consultations.

PURPOSE: Non-urgent face-to-face outpatient ophthalmology appointments were suspended in the United Kingdom in March 2020, due to the COVID-19 outbreak. In common with other centres, Moorfields Eye Hospital NHS Foundation Trust (London) offered modified telephone consultations to new and follow-up patients in the low vision clinic. Here we assess the success of this telephone service. METHODS: Data were collected for 500 consecutive telephone low vision appointments. Successful completion of the assessment and clinical outcomes (low vision aids prescribed, onward referral) were recorded. RESULTS: Telephone assessments were completed for 364 people (72.8%). The most common reasons for non-completion were either no answer to the telephone call (75 people, 15%), or the patient declining assessment (20 people, 4%). There was no association between age and the likelihood of an assessment being completed. 131 new low vision aids were dispensed, 77 internal referrals were made and 15 people were referred to outside services. More than 80% of the low vision aids prescribed were useful. CONCLUSIONS: Telephone low vision assessments were completed in about three-quarters of cases. About one-quarter of consultations resulted in new low vision aids being dispensed, which were generally found useful. Telephone low vision assessments can be used successfully in a large low vision clinic, but have many limitations when compared to face-to-face assessments.

Evaluation of a Home-Printable Vision Screening Test for Telemedicine.

Importance: Many ophthalmology appointments have been converted to telemedicine assessments. The use of a printed vision chart for ophthalmology telemedicine appointments that can be used by people who are excluded from digital testing has yet to be validated. Objectives: To evaluate the repeatability of visual acuity measured using the Home Acuity Test (HAT) and the agreement between the HAT and the last in-clinic visual acuity. Design, Setting, and Participants: This diagnostic study was conducted from May 11 to 22, 2020, among 50 control participants and 100 adult ophthalmology outpatients who reported subjectively stable vision and were attending routine telemedicine clinics. Bland-Altman analysis of corrected visual acuity measured with the HAT was compared with the last measured in-clinic visual acuity on a conventional Early Treatment Diabetic Retinopathy Study logMAR chart. Main Outcomes and Measures: For control participants, repeatability of the HAT and agreement with standard logMAR visual acuity measurement. For ophthalmology outpatients, agreement with the last recorded in-clinic visual acuity and with the International Classification of Diseases and Related Health Problems, 11th Revision visual impairment category. Results: A total of 50 control participants (33 [66%] women; mean [SD] age, 36.0 [10.8] years) and 100 ophthalmology patients with a wide range of diseases (65 [65%] women; mean [SD] age, 55.3 [22.2] years) were recruited. For control participants, mean (SD) test-retest difference in the HAT line score was -0.012 (0.06) logMAR, with limits of agreement (LOA) between -0.13 and 0.10 logMAR. The mean (SD) difference in visual acuity compared with conventional vision charts was -0.14 (0.14) logMAR (range, -0.4 to 0.18 log MAR) (-7 letters) in controls, with LOA of -0.41 to 0.12 logMAR (-20 to 6 letters). For ophthalmology outpatients, the mean (SD) difference in visual acuity was -0.10 (0.17) logMAR (range, -0.5 to 0.3 logMAR) (1 line on a conventional logMAR sight chart), with the HAT indicating poorer visual acuity than the previous in-clinic test, and LOA of -0.44 to 0.23 logMAR (-22 to 12 letters). There was good agreement in the visual impairment category for ophthalmology outpatients (Cohen κ = 0.77 [95% CI, 0.74-0.81]) and control participants (Cohen κ = 0.88 [95% CI, 0.88-0.88]). Conclusions and Relevance: This study suggests that the HAT can be used to measure visual acuity by telephone for a wide range of ophthalmology outpatients with diverse conditions. Test-retest repeatability is relatively high, and agreement in the visual impairment category is good for this sample, supporting the use of printed charts in this context.

Field trials of chemical suppression of embryonic cane toads (Rhinella marina) by older conspecifics.

Laboratory experiments have shown that the viability of embryos of the invasive cane toad (Rhinella marina) can be reduced by exposure to chemical cues from older conspecific larvae. These effects (very strong in laboratory trials) may offer an exciting new approach to controlling this problematic invasive species in Australia. However, the degree to which the method works in natural environments has yet to be assessed.Our experiments in the laboratory and in seminatural outdoor waterbodies show that chemical cues from tadpoles do indeed suppress the growth, development, and survival of conspecific larvae that are exposed as embryos and do so in a dose-dependent manner; higher tadpole densities cause greater suppression of embryos.In seminatural outdoor waterbodies, suppressor-exposed tadpoles were less than half as likely to survive to metamorphosis as were controls, and were much smaller when they did so and hence, less likely to survive the metamorph stage. Additionally, female cane toads were less likely to oviposit in a waterbody containing free-ranging (but not cage-enclosed) tadpoles, suggesting that the presence of tadpoles (rather than the chemical cues they produce) may discourage oviposition.Broadly, our results suggest that the suppression effect documented in laboratory studies does indeed occur in the field also, and hence that we may be able to translate that approach to develop new and more effective ways to reduce rates of recruitment of peri-urban populations of cane toads in their invasive range.

Everyday visual demands of people with low vision: A mixed methods real-life recording study.

Research has demonstrated that low vison aids (LVAs) can have a positive impact on the functional sight of those living with sight loss. Step changes in technology are now enabling new wearable LVAs with greater potential than those available previously. For these novel devices to receive increased acceptance and therefore adoption by those with sight loss, visual task demands have to be understood more clearly in order to enable better alignment between device design and user requirements. The aim of this study was to quantify these requirements. Thirty-two participants aged 18 to 87 wore a spectacle-mounted video camera to capture and narrate all everyday situations in which they would use a "perfect" sight aid during 1 week. Captured scenes were analyzed through categorization and computational image analysis. Results showed large variation in activities and lifestyles. Participants reported no available sight aid or coping strategy for 57% of the recorded activities. Reading made up 49% of all recorded tasks, the other half comprising non-textual information. Overall, 75% of captured activities were performed ad hoc (duration of 0-5 minutes), 78% occurred indoors, 58% occurred at home, 48% were lit by natural light, 68% included the object of interest within reach, and 69% required a single focus plane only. Around half of captured objects of interest had a size of 2 degrees visual angle (2.08 logarithm of the minimum angle of resolution [logMAR]) or smaller. This study highlights the need for a sight aid that can make both textual and non-textual scenes accessible while offering flexibility to accommodate individual lifestyles.